<form id="form1" method="post" style="margin:10px;">
	<div class="fitem" >
		<label style="width:120px">No KTP</label>:
		<input name="no_ktp" size="15" required="true" value="<?=$no_ktp?>">
	</div>
	<div class="fitem" >
		<label style="width:120px">Nama </label>:
		<input name="nama" size="20" required="true" value="<?=$nama?>">
	</div>
	<div class="fitem" >
		<label style="width:120px">Agama</label>:
		<select id="agama" name="agama">
			<option value="">- Pilih -</option>
			<option value="Islam" <?= $agama == 'Islam'?'selected ="selected"':''; ?>>Islam</option>
			<option value="Kristen" <?= $agama == 'Kristen'?'selected ="selected"':''; ?>>Kristen</option>
			<option value="Hindu" <?= $agama == 'Hindu'?'selected ="selected"':''; ?>>Hindu</option>
			<option value="Budha" <?= $agama == 'Budha'?'selected ="selected"':''; ?>>Budha</option>
		</select></li>
	</div>
	<div class="fitem" >
		<label style="width:120px">Tempat Lahir </label>:
		<input name="t_lahir" size="15" required="true" value="<?=$t_lahir?>">

	</div>
	<div class="fitem" >
		<label style="width:120px">Tanggal Lahir</label>:
			<input class="easyui-datebox" name="tgl_lahir" size="13" value="<?=$tgl_lahir?>" id="tgl_lahir" data-options="formatter:DateFormatter, parser:DateParser">
		<label>
	</div>
	<div class="fitem" >
		<label style="width:120px">Jenis Kelamin</label>:
		<select id="j_kel" name="j_kel">
			<option value="">- Pilih -</option>
			<option value="L" <?= $j_kel == 'L'?'selected ="selected"':''; ?>>Laki - Laki</option>
			<option value="W" <?= $j_kel == 'W'?'selected ="selected"':''; ?>>Wanita</option>
		</select></li>
	</div>
	<div class="fitem" >
		<label style="width:120px">Golongan Darah</label>:
		<select id="gol_darah" name="gol_darah">
			<option value="">- Pilih -</option>
			<option value="A" <?= $gol_darah == 'A'?'selected ="selected"':''; ?>>A</option>
			<option value="B" <?= $gol_darah == 'B'?'selected ="selected"':''; ?>>B</option>
			<option value="AB" <?= $gol_darah == 'AB'?'selected ="selected"':''; ?>>AB</option>
			<option value="O" <?= $gol_darah == 'O'?'selected ="selected"':''; ?>>O</option>
		</select></li>
	</div>
	<div class="fitem" >
		<label style="width:120px">Warga Negara </label>:
		<input name="w_negara" size="15" required="true" value="<?=$w_negara?>">
	</div>
	<div class="fitem" >
		<label style="width:120px">Pendidikan </label>:
		<input name="pendidikan" size="15" required="true" value="<?=$pendidikan?>">
	</div>
	<div class="fitem" >
		<label style="width:120px">Pekerjaan </label>:
		<input name="pekerjaan" size="20" required="true" value="<?=$pekerjaan?>">
	</div>
	<div class="fitem" >
		<label style="width:120px">Status</label>:
		<select id="s_nikah" name="s_nikah">
			<option value="">- Pilih -</option>
			<option value="belum_menikah" <?= $s_nikah == 'belum_menikah'?'selected ="selected"':''; ?>>Belum Menikah</option>
			<option value="menikah" <?= $s_nikah == 'menikah'?'selected ="selected"':''; ?>>Menikah</option>
			<option value="janda/duda" <?= $s_nikah == 'janda/duda'?'selected ="selected"':''; ?>>Janda/Duda</option>
			<option value="lainnya" <?= $s_nikah == 'lainnya'?'selected ="selected"':''; ?>>Lain-Lain</option>
		</select></li>
	</div>
	<div class="fitem" >
		<label style="width:120px">Tahun Terdaftar </label>:
		<input name="thn_daftar" size="15" required="true" value="<?=$thn_daftar?>">
	</div>
</form>
	

